Nanoporous graphene-based thin-film microelectrodes for in vivo high-resolution neural recording and stimulation.

One of the critical factors determining the performance of neural interfaces is the electrode material used to establish electrical communication with the neural tissue, which needs to meet strict electrical, electrochemical, mechanical, biological and microfabrication compatibility requirements. This work presents a nanoporous graphene-based thin-film technology and its engineering to form flexible neural interfaces. The developed technology allows the fabrication of small microelectrodes (25 µm diameter) while achieving low impedance (∼25 kΩ) and high charge injection (3-5 mC cm-2). In vivo brain recording performance assessed in rodents reveals high-fidelity recordings (signal-to-noise ratio >10 dB for local field potentials), while stimulation performance assessed with an intrafascicular implant demonstrates low current thresholds (<100 µA) and high selectivity (>0.8) for activating subsets of axons within the rat sciatic nerve innervating tibialis anterior and plantar interosseous muscles. Furthermore, the tissue biocompatibility of the devices was validated by chronic epicortical (12 week) and intraneural (8 week) implantation. This work describes a graphene-based thin-film microelectrode technology and demonstrates its potential for high-precision and high-resolution neural interfacing.

Nuclear and chloroplast DNA phylogeography reveals high genetic diversity and postglacial range expansion in Quercus mexicana.

PREMISE: Phylogeographical studies are fundamental for understanding factors that influence the spatial distribution of genetic lineages within species. Population expansions and contractions, distribution shifts, and climate changes are among the most important factors shaping the genetic compositions of populations. METHODS: We investigated the phylogeography of an endemic oak, Quercus mexicana (Fagaceae), which has a restricted distribution in northeastern Mexico along the Sierra Madre Oriental and adjacent areas. Nuclear and chloroplast DNA microsatellite markers were used to describe the genetic diversity and structure of 39 populations of Q. mexicana along its entire distribution area. We tested whether population expansion or contraction events influenced the genetic diversity and structure of the species. We also modeled the historical distributional range of Q. mexicana (for the Mid Holocene, the Last Glacial Maximum, and the Last Interglacial) to estimate the extent to which climate fluctuations have impacted the distribution of this oak species. RESULTS: Our results revealed high genetic diversity and low genetic structure in Q. mexicana populations. Ecological niche models suggested historical fluctuations in the distributional range of Q. mexicana. Historical range changes, gene flow, and physical barriers seem to have played an important role in shaping the phylogeographic structure of Q. mexicana. CONCLUSIONS: Our study indicates that the genetic structure of Q. mexicana may have been the result of responses of oak trees not only to heterogeneous environments present in the Sierra Madre Oriental and adjacent areas, but also to elevational and latitudinal shifts in response to climate changes in the past.

Producción latinoamericana sobre investigación formativa en Scopus / Latin American production on formative research in Scopus

Introducción: La producción científica latinoamericana aún no es la esperada. Por ello tiene importancia analizar la actividad científica sobre investigación formativa en esta parte del mundo. Objetivo: Evaluar la producción latinoamericana sobre investigación formativa en Scopus en el período 2010-2020. Métodos: Estudio descriptivo retrospectivo. Las unidades de análisis fueron publicaciones sobre investigación formativa en revistas indizadas en la base de datos Scopus durante 2010-2020, y cuya autoría hacía mención a filiaciones de entidades latinoamericanas. Resultados: Se encontró un total de 120 artículos publicados con autoría a afiliaciones de instituciones latinoamericanas. Colombia es el país que contribuye con mayor producción científica sobre este tema, seguido por México, Perú y Brasil, que sobrepasan el 10 por ciento de la producción latinoamericana. En cuanto a la productividad por institución, 83 instituciones internacionales han participado en la producción latinoamericana sobre investigación formativa, entre los que destacan instituciones de México, Perú y Colombia con 4 y más artículos publicados. Conclusiones: La producción latinoamericana sobre investigación formativa entre 2010 y 2020 fue de 120 artículos en revistas indizadas en Scopus, con un porcentaje mayoritario de artículos de investigación, procedentes de Colombia, México y Perú. La institución con más producción resultó el Instituto Nacional de Salud Pública de México, y como las revistas con mayor cantidad de artículos aparecieron Q1 y Q2, con presencia de autores peruanos, brasileros y mexicanos(AU)

Introduction: Latin American scientific production is not yet as expected. Therefore, it is important to analyze the scientific activity on formative research in this part of the world. Objective: To evaluate the Latin American production on formative research in Scopus in the period 2010-2020. Methods: Retrospective descriptive study. The units of analysis were publications on formative research in journals indexed in the Scopus database during 2010-2020, and whose authorship mentioned affiliations with Latin American institutions. Results: A total of 120 published articles were found with authorship to affiliations of Latin American institutions. Colombia is the country that contributes with the highest scientific production on this subject, followed by Mexico, Peru and Brazil, which exceed 10 percent of the Latin American production. In terms of productivity by institution, 83 international institutions have participated in the Latin American production on formative research, among which institutions from Mexico, Peru and Colombia stand out with 4 or more published articles. Conclusions: The Latin American production on formative research between 2010 and 2020 was 120 articles in journals indexed in Scopus, with a majority percentage of research articles, coming from Colombia, Mexico and Peru. The institution with the highest production was the National Institute of Public Health of Mexico, and the journals with the highest number of articles were Q1 and Q2, with the presence of Peruvian, Brazilian and Mexican authors(AU)

Characterization and Identification of Probiotic Features in Lacticaseibacillus Paracasei Using a Comparative Genomic Analysis Approach.

Lacticaseibacillus paracasei species are widely used for their health-promoting properties in food and agricultural applications. These bacteria have been isolated from various habitats such as the oral cavity, cereals, vegetables, meats, and dairy products conferring them the ability to consume different carbohydrates. Two subspecies are recognized, Lacticaseibacillus paracasei subsp. paracasei and Lacticaseibacillus paracasei subsp. tolerans according to their acid production from carbohydrates. Some strains are currently used as probiotics. In this study, we performed a comparative genomic analysis of 181 genomes of the Lacticaseibacillus paracasei species to reveal genomic differences at the subspecies level and to reveal adaptive and probiotic features, and special emphasis is given to inulin consumption. No clear distinction at the subspecies level for L. paracasei was shown using a phylogenetic tree with orthologous genes from the core-genome set. In general, a good correlation was observed between genomic distance and isolation origin, suggesting that L. paracasei strains are adapted to their natural habitat, giving rise to genetic differences at the genomic level. A low frequency of undesirable characteristics such as plasmids, prophages, antibiotic resistance genes, absence of virulence factors, and frequent bacteriocin production supports these species being good candidates for use as probiotics. Lastly, we found that the inulin gene cluster in L. paracasei strains seems to differ slightly in the presence or absence of some genes but maintains a core defined by at least three fructose-PTS proteins, one hypothetical protein, and extracellular ß-fructosidase. Finally, we conclude that further work has to be done for L. paracasei subspecies classification. Improving outgroup selection criteria is a key factor for their correct subspecies assignation.

Vagus nerve stimulation does not improve recovery of forelimb motor or somatosensory function in a model of neuropathic pain.

Nerve injury affecting the upper limb is a leading cause of lifelong disability. Damage to the nerves in the arm often causes weakness and somatosensory dysfunction ranging from numbness to pain. Previous studies show that combining brief bursts of electrical vagus nerve stimulation (VNS) with motor or tactile rehabilitation can restore forelimb function after median and ulnar nerve injury, which causes hyposensitivity of the ventral forelimb. Here, we sought to determine whether this approach would be similarly effective in a model of radial nerve injury that produces allodynia in the ventral forelimb. To test this, rats underwent complete transection of the radial nerve proximal to the elbow followed by tubular repair. In the first experiment, beginning ten weeks after injury, rats received six weeks of tactile rehabilitation, consisting of mechanical stimulation of either the dorsal or ventral region of the forepaw in the injured limb, with or without concurrent VNS. In a second experiment, a separate cohort of rats underwent six weeks of forelimb motor rehabilitative training with or without paired VNS. Contrary to findings in previous models of hyposensitivity, VNS therapy fails to improve recovery of either somatosensory or motor function in the forelimb after radial nerve injury. These findings describe initial evidence that pain may limit the efficacy of VNS therapy and thus highlight a characteristic that should be considered in future studies that seek to develop this intervention.

Intravaginal misoprostol versus uterine curettage for missed abortion: A cost-effectiveness analysis.

PURPOSE: To evaluate the cost-effectiveness of a strategy based on direct-acting uterine curettage (UC) versus a pre-direct-acting misoprostol (1600 mg) in patients with missed abortion (MA), from the perspective of a National Health System. METHODS: An open prospective cohort study was carried out at Reina Sofía University Hospital (Córdoba, Spain) from January 1, 2019 to December 31, 2019 in 180 patients diagnosed with MA. The patients chose medical treatment with intravaginal misoprostol (800 µg/4 h) or UC after receiving complete and detailed information. The effectiveness, clinical characteristics of the patients, costs of treating and managing the disease, and satisfaction with the procedures were recorded. RESULTS: One hundred and forty-five patients (80.6%) chose misoprostol versus 35 patients (19.4%) who chose UC. The effectiveness of misoprostol has been 42% evaluated at 48 h; UC success rate has been 100%. The incidence of side effects is significantly higher in patients treated with misoprostol (p < 0.05); as well as the number of care received by the patient (p < 0.05). Satisfaction is higher in patients treated with UC (p < 0.05). However, the cost is almost 5-folds higher in patients treated with UC (p < 0.05). CONCLUSION: UC has a higher success rate, greater satisfaction, and a lower incidence of side effects, although significantly increases the cost compared to misoprostol in MA.

The role of wood anatomical traits in the coexistence of oak species along an environmental gradient.

Oaks (Quercus) are a dominant woody plant genus in the northern hemisphere, which occupy a wide range of habitats and are ecologically diverse. We analysed the wood anatomical traits, the variables derived and the relative hydraulic conductivity of 21 oak species to identify their performance according to abiotic factors, leaf phenological patterns and phylogenetic restrictions by analysing the interspecific variation along an environmental gradient. First, we determine the causes of anatomical trait variation in the oaks, analysing the functional trade-offs related to distribution along the environmental gradient. We measure the phenotypic plasticity of the anatomical traits to determine the role of environment and geographic distance in the range of phenotypic plasticity. Second, we examined if oaks co-occurred along the environmental gradient. Then we analysed if wood anatomical traits reflect differences among their phylogenetic section, leaf habit and a phylogenetic section/leaf habit category. Last, we tested the phylogenetic signal. Our results showed that vessel diameter, vessel frequency, wood density and relative hydraulic conductivity are the main axes of trait variation in the species analysed among leaf habit categories. The aridity index and seasonal precipitation drive the variation in the analysed traits. Higher environmental distance resulted in a higher relative distance plasticity index among traits. Co-occurrence of oak species with different leaf habits and phylogenetic trajectories may promote complementary resource acquisition. The phylogenetic signal in the oak species studied was low, which implies labile wood traits.

Comparative Genomic Analysis of Novel Bifidobacterium longum subsp. longum Strains Reveals Functional Divergence in the Human Gut Microbiota.

Bifidobacterium longum subsp. longum is a prevalent group in the human gut microbiome. Its persistence in the intestinal microbial community suggests a close host-microbe relationship according to age. The subspecies adaptations are related to metabolic capabilities and genomic and functional diversity. In this study, 154 genomes from public databases and four new Chilean isolates were genomically compared through an in silico approach to identify genomic divergence in genes associated with carbohydrate consumption and their possible adaptations to different human intestinal niches. The pangenome of the subspecies was open, which correlates with its remarkable ability to colonize several niches. The new genomes homogenously clustered within subspecies longum, as observed in phylogenetic analysis. B. longum SC664 was different at the sequence level but not in its functions. COG analysis revealed that carbohydrate use is variable among longum subspecies. Glycosyl hydrolases participating in human milk oligosaccharide use were found in certain infant and adult genomes. Predictive genomic analysis revealed that B. longum M12 contained an HMO cluster associated with the use of fucosylated HMOs but only endowed with a GH95, being able to grow in 2-fucosyllactose as the sole carbon source. This study identifies novel genomes with distinct adaptations to HMOs and highlights the plasticity of B. longum subsp. longum to colonize the human gut microbiota.

The tactile experience paired with vagus nerve stimulation determines the degree of sensory recovery after chronic nerve damage.

Loss of sensory function is a common consequence of neurological injury. Recent clinical and preclinical evidence indicates vagus nerve stimulation (VNS) paired with tactile rehabilitation, consisting of delivery of a variety of mechanical stimuli to the hyposensitive skin surface, yields substantial and long-lasting recovery of somatosensory function after median and ulnar nerve transection and repair. Here, we tested the hypothesis that a specific component of the tactile rehabilitation paired with VNS is necessary for recovery of somatosensory function. In a second experiment in a separate cohort, we investigated whether VNS paired with tactile rehabilitation could improve skilled forelimb motor function. Elements of the study design, including planned sample size, assessments, and statistical comparisons, were preregistered prior to beginning data collection (https://osf.io/3tm8u/). Animals received a peripheral nerve injury (PNI) causing chronic sensory loss. Eight weeks after injury, animals were given a VNS implant followed by six weeks of tactile rehabilitation sessions consisting of repeated application of one of two distinct mechanical stimuli, a filament or a paintbrush, to the previously denervated forepaw. VNS paired with either filament indentation or brushing of the paw significantly improved recovery of forelimb withdrawal thresholds after PNI compared to tactile rehabilitation without VNS. The effect size was twice as large when VNS was paired with brushing compared to VNS paired with point indentation. An independent replication in a second cohort confirmed that VNS paired with brush restored forelimb withdrawal thresholds to normal. These rats displayed significant improvements in performance on a skilled forelimb task compared to rats that did not receive VNS. These findings support the utility of pairing VNS with tactile rehabilitation to improve recovery of somatosensory and motor function after neurological injury. Additionally, this study demonstrates that the sensory characteristics of the rehabilitation paired with VNS determine the degree of recovery.

Use of BioFire FilmArray gastrointestinal PCR panel associated with reductions in antibiotic use, time to optimal antibiotics, and length of stay.

BACKGROUND: Rapid and accurate diagnostic tools are needed for appropriate management of infectious diarrhea. METHODS: We evaluated the impact of the introduction of rapid multiplex PCR testing using the FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, LLC, Salt Lake City, UT) at our institution, and compared the results to those of standard stool cultures. RESULTS: The most common pathogens detected by the FilmArray GI panel were Clostridium difficile (55.0%), Campylobacter species (20.9%), Salmonella species (12.4%), and Shigella/EIEC species (12.4%). Rates of reproducibility in stool culture for these pathogens ranged from 56.3 to 77.8%. Co-detection of two or more organisms was common (24.2%), most commonly involving EPEC, EAEC, ETEC, and STEC. The time from arrival in the Emergency Department to discharge or admission to the hospital was unchanged after the introduction of FilmArray GI panel, but length of hospital stay was shorter (3 vs. 7.5 days, p = 0.0002) for the FilmArray group. The time to empiric antibiotics did not differ significantly, but optimal antibiotics were started earlier after introduction of the FilmArray GI panel (hospital day 1 vs. 2, p < 0.0001). More patients were discharged without antibiotics after introduction of the FilmArray GI panel (14.0% vs. 4.5%; p < 0.001). CONCLUSION: Our results demonstrate that the FilmArray GI panel is an important tool for improving both patient care and antibiotic stewardship, despite the tendency for positive results with multiple pathogens.

Vagus Nerve Stimulation Paired With Rehabilitative Training Enhances Motor Recovery After Bilateral Spinal Cord Injury to Cervical Forelimb Motor Pools.

Closed-loop vagus nerve stimulation (VNS) paired with rehabilitative training has emerged as a strategy to enhance recovery after neurological injury. Previous studies demonstrate that brief bursts of closed-loop VNS paired with rehabilitative training substantially improve recovery of forelimb motor function in models of unilateral and bilateral contusive spinal cord injury (SCI) at spinal level C5/6. While these findings provide initial evidence of the utility of VNS for SCI, the injury model used in these studies spares the majority of alpha motor neurons originating in C7-T1 that innervate distal forelimb muscles. Because the clinical manifestation of SCI in many patients involves damage at these levels, it is important to define whether damage to the distal forelimb motor neuron pools limits VNS-dependent recovery. In this study, we assessed recovery of forelimb function in rats that received a bilateral incomplete contusive SCI at C7/8 and underwent extensive rehabilitative training with or without paired VNS. The study design, including planned sample size, assessments, and statistical comparisons, was preregistered prior to beginning data collection ( https://osf.io/ysvgf/ ). VNS paired with rehabilitative training significantly improved recovery of volitional forelimb strength compared to equivalent rehabilitative training without VNS. Additionally, VNS-dependent enhancement of recovery generalized to 2 similar, but untrained, forelimb tasks. These findings indicate that damage to alpha motor neurons does not prevent VNS-dependent enhancement of recovery and provides additional evidence to support the evaluation of closed-loop VNS paired with rehabilitation in patients with incomplete cervical SCI.

Restoration of Somatosensory Function by Pairing Vagus Nerve Stimulation with Tactile Rehabilitation.

OBJECTIVE: Sensory dysfunction is a common consequence of many forms of neurological injury, including stroke and nerve damage. Rehabilitative paradigms that incorporate sensory retraining can provide modest benefits, but the majority of patients are left with lasting sensory loss. We have developed a novel strategy that uses closed-loop vagus nerve stimulation (VNS) paired with tactile rehabilitation to enhance synaptic plasticity and facilitate recovery of sensory function. METHODS: A clinical case report provides initial evidence that a similar implementation of closed-loop VNS paired with a tactile rehabilitation regimen could improve recovery of somatosensory function. Here, we sought to build on these promising initial clinical data and rigorously evaluate the ability of VNS paired with tactile rehabilitation to improve recovery in an animal model of chronic sensory loss. The study design, including planned sample size, assessments, and statistical comparisons, was preregistered prior to beginning data collection (https://osf.io/xsnj5/). RESULTS: VNS paired with tactile rehabilitation resulted in a significant and nearly complete recovery of mechanosensory withdrawal thresholds. Equivalent tactile rehabilitation without VNS failed to improve sensory function. This VNS-dependent restoration of sensory thresholds was maintained for several months after the cessation of stimulation, illustrating long-term benefits. Moreover, VNS paired with tactile rehabilitation resulted in significant generalized improvements in other measures of sensorimotor forepaw function. INTERPRETATION: Given the safety and tolerability of VNS therapy, these findings suggest that incorporating VNS paired with sensory retraining into rehabilitative regimens may represent a fundamentally new method to increase recovery of sensory function after neurological injury. ANN NEUROL 2020;87:194-205.

Streptobacillus moniliformis mitral valve endocarditis and septic arthritis: the challenges of diagnosing rat-bite fever endocarditis.

Streptobacillus moniliformis, the cause of rat-bite fever (RBF) in the United States, has rarely been reported as a cause of infectious endocarditis. In the majority of previously reported cases, the diagnosis was clinically- based in patients with underlying valvular abnormalities in the setting of positive blood culture for Streptobacillus moniliformis. We report a case of native valve endocarditis secondary to Streptobacillus moniliformis in a woman with a mitral valve vegetation but negative blood cultures where the diagnosis was established using molecular diagnostics on the valvular tissue.

Pennation angle of vastus laterallis during isometric contractions performed at two knee angles / Ângulo de penação do vasto lateral durante contrações isométricas executadas em dois ângulos do joelho

Abstract Introduction: The pennation angle (PA) of a muscle is not static value, but it adapts to the conditions imposed by the contraction intensity required. Objective: This study investigates the effect of knee angle (KA) and intensity of contraction (IC) on PA of vastus lateralis (VL). Methods: Eight women and nine men executed isometric torques lasting 5s at the maximal voluntary contraction (MVC), 25%, 50% and 75% of MVC, on an isokinetic dynamometer with the KA at 90° and 120° (full extension = 180°). The PA was measured in each test, and with the subject relaxed. The effect of IC on PA was tested by means of repeated measures ANOVA and effect size (ES), and of the KA on PA by paired t test, employed on each IC, together with the statistics: intraclass correlation (ICC), standard error of measurement (SEM) and ES, all calculated with the PAs measured at both KAs. Results: The PA increased significantly and successively with the IC (p < 0.05; ES between 1.11 and 3.04), but was not influenced by KA (p > 0.05; ICC between 0.70 and 0.81; SEM between 0.7° and 1.4°; ES between 0.02 and 0.2). Conclusion: The successive increase of PA with the IC supports the existence of relation between these variables. While studies advocate the effect of PA on joint angle this was not observed in this study, probable because the 30o of between KA difference employed was not enough to provide change in PA.

Resumo Introdução: O ângulo de penação (AP) de um músculo não é estático, podendo se adaptar às condições impostas pela contração demandada. Objetivo: Este estudo investigou a influência do ângulo do joelho (AJ) e da intensidade da contração (IC) no AP do vasto lateral (VL). Métodos: Oito mulheres e nove homens executaram torques isométricos durante 5s na contração voluntária máxima (CVM), em 25%, 50% e 75% da CVM, em um equipamento isocinético, com o AJ em 90° e 120° (extensão = 180°). O AP foi medido nos testes e com o sujeito relaxado. O efeito da IC no AP foi testado por ANOVA para medidas repetidas e pelo tamanho do efeito (TE), e o do AJ no AP, por teste t pareado, aplicado a cada IC, junto com as estatísticas: coeficiente de correlação intraclasse (ICC), erro padrão da medida (SEM) e TE, todas calculadas com os APs medidos em ambos AJs. Resultados: O AP aumentou significativamente e sucessivamente com a IC (p < 0,05; TE entre 1,11 e 3,04), mas não foi influenciado pelo AJ (p > 0,05; ICC entre 0,70 e 0,81; SEM entre 0,7° e 1,4°; TE entre 0,02 e 0,20). Conclusão: O aumento sucessivo do AP com a IC corrobora a existência de relação entre estas duas variáveis. Enquanto estudos advogam efeito do ângulo articular no AP, isto não foi observado neste estudo, provavelmente porque a diferença de 30° utilizada entre os AJ não foi suficiente para produzir mudança no AP.

Primary Histoplasma capsulatum Enterocolitis Mimicking Peptic and Inflammatory Bowel Disease.

In immunocompromised patients, histoplasmosis may present as disseminated disease. We present a 52-year-old Caucasian male with symptoms of dyspepsia, postprandial epigastric pain, nausea, and nonbloody diarrhea. Upper and lower gastrointestinal endoscopies were suspicious for inflammatory bowel disease (IBD); however, biopsies were consistent with histoplasmosis, specifically in the duodenum.

Rapidly Progressive Seeding of a Community Acquired Pathogen in an Immune-competent Host--End Organ Damage from Head to Bone.

This report describes a 64-years-old male patient that presented to our hospital with a chief complaint of acute worsening of his usual chronic lower back pain, progressive weakness in lower extremities and subjective fevers at home. Spine CT failed to demonstrate any infectious foci but showed partially visualized lung cavitary lesion and renal pole abnormalities. Blood cultures grew methicillin-sensitive Staphylococcus Aureus (MSSA). Transthoracic echocardiogram (TTE) showed no signs of infective endocarditis (IE). Later, the patient experienced an acute deterioration on clinical status and examination showed development of a new murmur. He also developed new hemiparesis with up-going babinski reflex. A head MRI showed multiple infarcts. MRI spine displayed osteomyelitis at T12-L1. Cerebro-spinal fluid was positive for meningitis. A transesophageal echocardiogram (TEE) was performed demonstrating new severe mitral and mild tricuspid regurgitations with a definitive 1.5 cm mobile vegetation on posterior mitral leaflet. We present is a very interesting case of a rapidly progressive MSSA infection. MSSA meningitis is a rare disease; there are only few reported cases in the literature to date. We describe a case of MSSA bacteremia, of questionable source, that resulted in MSSA endocarditis affecting right and left heart in a patient who did not have a history of intravenous drug use (IVDU) or immunosuppression. The case was complicated by septic emboli to systemic circulation involving the kidneys, vertebral spine (osteomyelitis), lungs and brain with consequent meningitis and stroke. Even when MSSA infections are well known, to our knowledge there are no previous case reports describing such an acute-simultaneous-manifestation of multi-end-organ failure, including meningitis and stroke. These latter are rarely reported, even individually.

Rapid Progressive Seeding of a Community Acquired Pathogen in an Immune-Competent Host: End Organ Damage from Head to Bone.

Methicillin-sensitive Staphylococcus aureus (MSSA) meningitis is a rare disease when not related to neurosurgery: there are only few reported cases in the literature to date. We describe a case that highlights not only meningeal but also diffuse and rapidly progressive systemic involvement with multi-organ failure. A 64-year-old male presented to our hospital with a chief complaint of acute worsening of his usual chronic lower back pain, progressive weakness in lower extremities and subjective fevers at home. Hospital course demonstrated MSSA bacteremia, of questionable source, that resulted in endocarditis affecting right and left heart in a patient with no history of intravenous drug use. The case was complicated by septic emboli to systemic circulation involving the kidneys, vertebral spine, lungs and brain with consequent meningitis and stroke, even when treated empirically with vancomycin and then switched to nafcillin as indicated. Even though MSSA infections are well known, there are very few case reports describing such an acute-simultaneous-manifestation of multi-end-organ failure, including meningitis and stroke. Our case, also presented with an uncommon manifestation of persistent infection dissemination despite adequate antibiotic treatment.

How an Opportunistic Infection Can Mess with Your Brain and Take Your Breath Away: A Rare Case of Simultaneous Lung and Brain Abscess due to Streptococcus anginosus.

Streptococcus anginosus (S. anginosus) is considered a friendly bug and is a one of many different bacteria that constitute the normal flora of the oral cavity. Nevertheless, it has been infrequently associated with more invasive infections, like lung abscess. It is extremely rare to have multisystemic involvement with S. anginosus group. We present a unique case of pulmonary and brain abscess due to S. anginosus in an immunocompetent patient.

Solid pseudopapillary pancreatic tumor as a portal hypertension causal: the first reported case in Puerto Rico.

We describe the first reported case in Puerto Rico of Solid Pseudopapillary Tumor (SPT) of the pancreas causing portal hypertension. Clinical presentation and characteristic imaging findings are helpful to differentiate SPT from pancreatic carcinoma. Diagnosis can be confirmed by histopathological and immunohistochemical approach through biopsy. Timely surgical intervention can prevent portal hypertension as manifestation and be lifesaving in case of malignant degeneration, giving the patient an excellent prognosis after tumor surgical resection.

New approaches to the biogeography and areas of endemism of red oaks (Quercus L., section Lobatae).

An area of endemism is defined by the spatial congruence among two or more species with distributions that are limited by barriers. In this study, we explored and discussed the use of the network analysis method (NAM) and neighbor-joining (NJ) to analyze the areas of endemism of Quercus sect. Lobatae (red oak species) in Mexico and Central America. We compared the NAM and NJ with other methods commonly used in biogeographic studies to show the advantages of these new approaches and to identify the shortcomings of other approaches. The NAM used in this study is based on notions of centrality measures, such as betweenness. We incorporated the strength of the ties within the internal networks through p-cores and aggregate constraints in iterative analyses. The NAM based on betweenness is ideal for recognizing completely allopatric areas of endemism. The iterative NAMs increase the number of possible areas of endemism because they minimize the effect of minimal overlap, and the p-core is efficient at identifying the closest relationships among species in the cases in which betweenness is not informative. The number of areas of endemism increases when the sympatry matrix minimizes the dispersal effect and the sample effort is maximized, allowing the identification of the greatest number of these areas. The NJ method supports the idea that areas diverge among themselves in a differential way; the long branches correspond to zones with high speciation rates and complex histories (biotic and tectonic), and the short branches correspond to zones with low speciation rates and simple histories. In a classification scheme, NJ was capable of identifying the areas that are considered biotically complex because of their high speciation rates. The results obtained with the NAM and NJ showed that the physiographic regions of Mexico are not natural units and that many of them are composed of at least two different biotic components.